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334: Exploring the Penile Prosthesis Procedure

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334: Exploring the Penile Prosthesis Procedure Courtesy of American Medical Systems EXPLORING THE Penile Prosthesis Procedure by Debbie Gutierrez, CST nsertion of a penile implant is often performed in men with erectile dysfunction. This Isurgery is performed when prescribed medications or penis pumps do not work for the patient.1 There are different types of implants used for this type of surgery. The two most popular types of implants are the inflatable implant and the semi-rigid implant. This procedure usually takes one to two hours and the patient usually is discharged the same day as the surgery.8 In this particular case study, the patient is a 60-year-old male who was scheduled to have outpatient surgery for the insertion of a semi-rigid prosthesis or implant. The patient’s height was six feet, three inches and weighed 180 pounds. The patient’s vital signs were taken preoperatively by the nurse: his blood pressure was 120/71; his heart rate was 83 beats per minute; his respirations were 18 breaths per minute; his oxygen saturation was at 96%; and his temperature was 36 degrees Celsius. His total Braden score was 23. The patient’s NPO status also was checked prior to surgery. He was NPO for 12 hours upon his arrival to the hospital.11 PATHOPHYSIOLOGY LEARNING OBJECTIVES The patient was diagnosed witha malfunctioning penile implant. The patient had an inflatable implant inserted three years prior to ▲ Learn about the procedure for the this surgery.11 The implant malfunctioned because the balloon or implantation of a penile prosthesis reservoir was leaking fluid. ▲ Compare the pros and cons of the The inflatable prosthesis has two silicone rods that are surgi- different types of penile implants cally placed inside both sides of the corpus cavernosum of the penis.9 A pump and a reservoir are attached together with tubes. ▲ Identify the equipment needed to The balloon or reservoir is filled with liquid and is placed under- insert a penile prosthesis neath the sartorius muscle and the adductor magnus muscle, ▲ Examine the complications that can the muscles of the groin. The pump lies in the scrotum and is occur with a penile implant attached with tubing to the reservoir and the silicone rods that are placed in the penis. The implant inflates and the liquid is dis- ▲ Access the relevant anatomy and placed or transported to the silicone rods in the corpus caverno- physiology associated with this sum of the penis. The water transports to and from the reservoir procedure OCTOBER 2011 | The Surgical Technologist | 447 tile dysfunction. The nerves of the penis could be damaged by a pelvic surgery. A prostatectomy is an example of a pelvic surgery that can lead to erectile dysfunc- tion. “Erectile dysfunction is essentially a vascular disease.”1 Some other causes of ED include diabetes mellitus and cardio- vascular disease. Males that suffer from type 2 diabetes have a higher risk of ED, and advancing age increases the risk by more than 15 percent. “It is been estimated that about 35-75% of men with diabetes will experi- ence at least some degree of erectile dys- function during their lifetime.”13 The nerves in the penis and the small blood vessels that supply the penis become damaged due to diabetes mellitus. The hormones produced in males may still allow them to feel like they can achieve an erection, but they physically are unable to.13 Cardiovascular disease also is associ- The 700 PS Approach 1-Piece Penile Prosthesis ated with erectile dysfunction. In males, COURTESY OF AMERICAN MEDICAL SYSTEMS smaller blood vessels in the extremities and the penis are the first parts in the body that have poor circulation due to and the pump. This action inflates and deflates the penis.14 vessel damage. “Studies estimate vascular diseases may be The fluid leak can occur in any part of the prosthesis. responsible for causing erectile dysfunction in as many as This type of complication can occur immediately following 50 to 70 percent of men who develop the condition.” Erec- surgery. This is due to improper implantation of the pros- tile dysfunction can be a sign of heart disease since it is thesis or a defect in the product. This requires the implant usually caught first; if males are experiencing erectile dys- to be replaced by a surgeon.2 Improper implantation is only function they should seek medical attention to check for one of the problems that can occur with a penile implant. any problems with cardiovascular disease.12 Other complications can include tubing kinks, aneurysm, lack of dilation of the cylinders, breakage of the wire, sili- DIAGNOSTIC TESTING cone spillage, loss of rigidity to the prosthesis, erosion of A patient history and physical is taken for every patient. For the reservoir, spontaneous deflation, spontaneous inflation, this patient, the physician conducted an H&P and a physi- penile curvature or pump or pump reservoir migration. cal examination. The doctor then inflated the prosthesis to Most male patients receive penile implants in order to treat make a diagnosis. An X-ray also was taken. Radiographic erectile dysfunction. Medications also can help with ED studies are done to find any malfunctions in the penile and surgery is considered a last resort. Erectile dysfunction implant. A contrast medium is used to fill the inflatable occurs more frequently in the United States because the life implant. This allows the doctor to see how the implant is expectancy is rising. It mostly affects males that are 65 and situated and to see if any fluid is leaking from it. The phy- older.1 “Approximately 25 million American men and their sician will take an X-ray of the implant while it is inflated partners are affected by erectile dysfunction, the inability and then again when it is deflated, allowing the physician to to achieve an erection.”3 There are different causes of erec- analyze the entire prosthesis system.2 448 | The Surgical Technologist | OCTOBER 2011 RELEVANT ANATOMY AND PHYSIOLOGY exterior via a slit-like opening, the external urethral orifice The penis, the male reproductive organ, is composed of or meatus.”5 spongy tissue and is separated into three parts. The parts are The penis’ blood supply comes from the dorsal artery called the corpus. “The cavernous structures of the penis, and the central artery. The two central arteries run through the two corpora cavernosa are positioned on the dorsal side the corpora cavernosa and the dorsal arteries are located on of the penis and lie side by side.5 The third corpus is called the dorsal side of the penis. The veins of the penis are called the corpus spongiosum. The corpus spongiosum is smaller the dorsal veins and the external pudendal veins. The dorsal and houses the urethra. The corpus spongiosum eventu- veins are located next to the dorsal arteries and the puden- ally forms the glans penis; this is the distal portion of the dal veins are located at the base of the penis. The dorsal penis. The corpora cavernosa are surrounded by connective nerve also runs on the dorsal side of the penis. tissue; this attaches the corpus spongiosum to the corpora The process of an erection occurs because of the auto- cavernosa. The foreskin, also called the prepuce, starts at nomic nervous system and the arteries and veins of the the base of the penis and extends over the glans penis. The penis. “Sexual arousal stimulates parasympathetic nerves foreskin is not thick and does not contain hair.5 The foreskin in the penis to release a compound called nitric oxide, can be removed by a circumcision, but it is not necessary.3 which activates the vascular smooth muscle enzyme gua- The head of the penis is called the corona. “The urethra nylyl cyclase.”3 This causes the rise in blood flow into the passes through the corpus spongiosum and opens to the penis. The blood enters the corpora cavernosa and creates COMPARING IMPLANT TYPES The decision about which type of implant is based on a patient’s preference and his medical situation. Factors including age, risk of infection, and health conditions, injuries or medical treatments should be considered before a penile prosthesis surgery.13 TYPE OF IMPLANT PROS CONS Three-piece • Creates a more natural erection than a semirigid • Has more parts that could malfunction than any inflatable implant other implant • Creates a firmer erection than a two-piece implant • Requires the most extensive surgery of any implant • Takes pressure off the inside of the penis when • Requires a reservoir inside the abdomen deflated, reducing the chance for injury Two-piece • Requires a less complicated surgery than the three- • Requires more extensive surgery than does a semi- inflatable piece implant rigid implant • Creates a more natural erection than a semirigid • Is mechanically more complicated than a semirigid implant implant • Takes pressure off the inside of the penis when • Results in a bulkier scrotum than a three-piece deflated, reducing the chance for injury implant • Provides less firm erections than a three-piece implant Semirigid • Requires the least extensive surgery of all implant • Results in a penis that is always slightly rigid types • Is more difficult to conceal under clothing than • Has fewer parts than any other implant, so less other devices chance of malfunction • Puts constant pressure on the inside of the penis, which can cause injury in some men OCTOBER 2011 | The Surgical Technologist | 449 Lonestar Retractor, the Dura Hooks to the Lonestar Retrac- The decision about which type of implant tor, Heagar Dilators, the surgeons gloves, suture, #15 blade, is based on a patient’s preference and his bulb syringe, extra Mayo stand cover, Foley catheter tray and instrument sets.
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